Cheryl Rae Blank, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

202 Issued in MT

Practice address

121 W Kagy Blvd
Bozeman, MT 59715-6000

Phone

(406) 587-7468

Fax

(406) 587-4520

NPI assigned

Apr 6, 2007

Last updated

Jan 3, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cheryl Blank, PH.D., P.C.

  • Clinical Psychologist
  • Bozeman, MT
  • NPI 1518159433
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294012800000",
    "number": "1932221058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4744 ITANA CIR",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597159330",
            "telephone_number": "406-579-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W KAGY BLVD",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156000",
            "telephone_number": "406-587-7468",
            "fax_number": "406-587-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "CHERYL",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2011-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MT",
            "license": "457",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MT",
            "license": "202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000490807",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW WEST",
            "identifier": "264349",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - MSU",
            "identifier": "51011",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI CARE",
            "identifier": "86-1155463",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - PRIVATE PRAC",
            "identifier": "52820",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Callie Ranae Blackwood, L.AC.
• Erica Leigh Blair, PCLC
• Steven Travis Blair, D.C.
• Sydney Blair
• Robert B Blake, M.D.
• Benjamin L Blend, M.D.
• Crystal Blixt, LMFT
• Melissa N Blixt, DNP, APRN, FNP-BC
• Blue Apple Wellness, LLP (Blue Apple Walk In Chiropractic)
• Blue River Counseling, LLC

• Psychologist in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Psychologist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.